Deathbed

and now was being put through a similar, but higher-level exam.

“Apparently,” said Koesler, “you came down here to ask Mr. Haroldson’s opinion. Why don’t you do that?”

“Oh, no, Father,” said the still-smiling Haroldson, “you’re the designated expert on theological matters. Why, young Dr. Anderson is in luck that you chanced to join us.”

I didn’t “chance” to join you, Koesler thought. You invited me to join you, you curmudgeon.

Anderson seemed to be playing the role of monkey in the middle. By this time, he didn’t much care which of them fielded the question.

Koesler inserted a single strand of fried potato in his mouth and thought. “Tie the tubes, eh?” he said. “It makes sense to me. And it might make glorious sense to the poor woman.”

“Then you think it would be morally acceptable to perform a tubal ligation!” Haroldson more challenged than questioned.

Koesler felt a moment of embarrassment as if he had given an incorrect answer in class. But he recovered quickly. “Well, yes. However you wish to figure it; a part for the whole, if you will. If it’s acceptable to perform a hysterectomy, it seems equally, if not more, acceptable to perform a lesser operation for the same purpose. The idea is this woman shouldn’t chance being pregnant again. Or, rather, that she can no longer depend on her womb to sustain a fetal life.”

“You’d allow that even though there is nothing whatsoever wrong with the Fallopian tubes!” Once again, Haroldson put an audible exclamation mark at the end of what might have been an honest question.

“Yes, I think so. It serves the same purpose and certainly makes more sense than a hysterectomy. As the Doctor here has said, it’s a trade of minor surgery for major. I think it’s the obvious conclusion.”

“And how would you justify that theologically, Father?” As time passed, Haroldson’s questions became more clearly a series of challenges. The plaster-of-paris smile began to fade as well.

“Justify it? What are you driving at?”

“What principle in moral theology would justify your conclusion, is what I’m driving at. Sounds like situation ethics to me!” It was evident from Haroldson’s inflection that he considered situation ethics a pejorative term.

Anderson glanced at his watch. Two things were certain: He had to get back to his hospital duties and his procedural dilemma had become a bone of contention between Haroldson and Koesler. “If you don’t mind, I’ll just get back to my rounds. I’ll get back in touch with you both later and find out what you decided.”

Anderson left the table. As far as Haroldson and Koesler were concerned it was as if the Doctor had never been there.

“Well, I’ll admit that, while I gave the uterus business some ‘theological’ consideration, the opinion on the tubes was sort of off the top of my head. But it certainly did not spring from situation ethics. I’m afraid I can’t subscribe to a school where all morality is weighed by an intention to do the ‘loving’ thing.”

“Well,” Haroldson said, “that’s refreshing. But then, may I ask what theological consideration you used to justify the original hysterectomy?”

For some reason, Haroldson seemed determined to keep Koesler in a pupil-teacher position.

“I suppose,” Koesler replied, “that would be the principle of the double effect.”

“You mean,” Haroldson corrected, “the principle of the indirect voluntary, of course.”

Damn, thought Koesler; he’s right. But he’s also nit-picking. Indirect voluntary was but the generic term under which fell the principle of the double effect. In either case, one dealt with a consequence that was not directly willed. Specifically, in the double effect, one posited an action from which flowed two distinct effects, one of which was “evil.” To be justified in traditional Catholic theology, the action must be good, or at least indifferent. The immediate consequence of the action must be good and the good must outweigh the evil of the secondary consequence, which, in turn, is not directly desired or willed but only permitted.

That, in a nutshell, was the principle of the indirect voluntary and its firstborn child, the principle of the double effect. And the insistence on a reference to the generic term was an indication to Koesler that Haroldson could be a difficult person with whom to do business.

“Yes,” Koesler admitted with little grace, “you’re right. It’s the principle of the indirect voluntary.”

“Exactly. The operation is not only warranted and good, it will happen of necessity because of the Caesarean delivery. The first and immediate effect of the surgery will be the removal of a worn-out, tired, and ineffective organ. And that is good, and it outweighs the contraceptive effect, which is not directly willed, but only tolerated.”

“Uh-huh.” No doubt about it, Koesler was becoming testy.

“And you feel the same reasoning applies to a tubal ligation in this case?” Haroldson made it seem a rhetorical question to which Koesler was about to wrongly respond.

“Yes, I do,” Koesler replied, giving, by Haroldson’s standards, the wrong answer.

“Would you mind explaining that, Father?”

“Look, I’ll admit we aren’t dealing directly with the defective organ. But in performing the hysterectomy the surgeon’s going to have to cut the Fallopian tubes anyway. So what’s the difference? What’s the difference if he cuts the tubes and then removes the defective uterus, or if he simply cuts the tubes, isolating the uterus, and leaves the organ there—to the great benefit of the patient?”

“The difference is, Father, that the surgeon is operating on a healthy organ and on a healthy organ alone. Thus making the action in se mala.”

It had been a long time since Koesler had heard the term evil in itself, or totally evil.

“And besides that, “ Haroldson continued, “the Pope had something to say about this!”

“The Pope?”

“Yes, the Pope!”

“Which one?”

“PiusXII.”

“That was a long time ago.”

“Words for the ages.”

“Well, what did he say?”

“That when someone halts ovulation to save a damaged uterus, that is direct sterilization and therefore illicit.”

“He was talking about the prevention of ovulation. At most that would refer to the antovulent pill.”

“Or to the Fallopian tubes that carry the ova.”

“I don’t think so. Besides, that opinion must go back to the forties or fifties.”

“Father! That is—”

“I know, I know: the ordinary magisterium.”

“Yes! The ordinary magisterium!”

“I don’t suppose it would help to point out that the usual teaching function of the Church has developed and changed over the years . . . make that over the centuries.”

“Father, since you are a part of this hospital, at least for the time being, maybe it would be good to know just what you believe. Just what theological school do you belong to? Vatican II? Vatican III? Vatican IV?”

Koesler laughed. “I believe about what you do, John, except not quite so rigidly.”

“Not so rigidly! Then you are a situationalist.”

“No. No, just someone who cannot help seeing some grays in moral theology.”

“Grays?”

“John, the theology we grew up with . . . well . . . it was the theology of The One, Holy, Catholic and Apostolic Church. There was development going on, but ever so slowly. And John, I don’t think it will ever be that way again.” Haroldson was about to interpose an objection, but Koesler quickly continued. “Not that I am about to adopt every new thought just because it’s new. But the theology we grew up with is based on a natural law ethic. It’s an absolute and objective sort of morality. And, on the one hand, I think there’s been considerable development in our understanding of the natural law. And, on the other, I think we can stand some mix of proportionalism where we weigh the proportion between good and evil, where the human person is the norm and each person is unique.

“Besides”—Koesler winked—“I’ll bet I could dig up a probable opinion to support doing a tubal ligation to